GeriPal Special: Hopes and Worries for Hospice and Palliative Care

Eric: Hey, GeriPal listeners, this is a GeriPal special episode. Alex, what’s going on here?

Alex: Well, Anne Kelly, she has a new stage name. Do you remember what it is?

Eric: Yeah. It was something like Anny Bannany the pianio…

Alex: Something about piano. She’s going to play piano on future GeriPal episodes. We look forward to that. She’s just resuming lessons. In any case, she gave us this idea that we should do the people on the street interview at the annual assembly of AAHPM and HPNA, so we did that.

Eric: Yeah, so we went around. Again, this was not an AHPM or HPNA sponsored thing, but we did go around people on the street asking them two questions: what’s one thing that you’re hoping for in the future of palliative care and hospice, and what’s another thing when you’re thinking about what you’re worried about for the field? These are excerpts – not everybody was included. Sorry if you weren’t included in this – just to hear a sense and the themes that came out when we were talking to people about what they’re hoping for and what they’re worried about. So take a listen.

BEGIN VIDEO:

Eric: When you think about the future for hospice and palliative medicine, what are you most hopeful for?

Attendee 1: For it to be integrated and for people to not have such long waits when getting established with a palliative care physician.

Attendee 2: With hospice and palliative medicine, I feel like it can help the communities, it can help the hospitals, so I feel really hopeful that it will be more and more into the practice of medicine.

Attendee 3: Oh. Well, I’m hopeful we’re going to see the passage of PCHETA and create opportunities for our junior faculty to have academic career awards. Something like the GACA that’s just such a transformative opportunity.

Eric: What is PCHETA?

Attendee 3: PCHETA, the Palliative Care Hospice and Education Training Act, of course.

Attendee 4: Oh, gosh. Young people are so smart. So if we can keep pulling in the young people, we’re going to be fine.

Eric: [funny blooper] Videographer, you’re not supposed to talk over the video. OMG. You can’t find any good help nowadays.

Attendee 4: I know. Tell me about it.

Eric: Martha, when you think about hospice and palliative medicine, what are you most hopeful for?

Attendee 5: That we are so integrated into the very fabric of healthcare that it’s a no-brainer in every single discipline because you know what? We are not an extra layer of support. We are actually the integrator. We deepen ourselves into the fabric of care and we make healthcare work for people who are seriously ill.

Eric: Martha – breaking the definition for palliative care, no longer an extra layer of support.

Attendee 6: I’m hopeful that we’re going to address that issue, that we’re really going to get it together and figure out, one, how do we find all the people who need palliative care? How do we reduce barriers to access for palliative care, and how do we ensure that people with serious illness and palliative care needs really get that care? We are working in that direction, and I’m optimistic that we’re going to get there.

Attendee 7: I’m hopeful because of all the great people who are in this space and who really care about it deeply.

Eric: Isn’t it great seeing everybody again?

Attendee 7: Incredible.

Attendee 8: I’m most hopeful for decreasing the burnout of our colleagues and helping them give the kind of care they want to give.

Attendee 9: Early integration of palliative care in medical education.

Eric: [funny blooper] Did I ask the same question? Did I say-

Attendee 9: You said what am I worried about?

Eric: [funny blooper] No, that was my first question too, was that my first question? I’m losing track.

Attendee 11: I am hopeful that the model of care that we deliver is what our patients and their caregivers want, need and deserve. So we need to understand how to get that front and center in how we care for people moving forward into the future.

Attendee 12: I’m hopeful for more access to people to have palliative care early, and I’m hopeful that we’re able to provide patients and families what they need, which is a lot more caregiving, which I feel like is a big thing that we’re missing in our healthcare.

Attendee 13: I am most hopeful that we will continue to really promote culture change for our healthcare system that desperately needs it.

Attendee 14: I am most hopeful that as palliative caregivers, we will continue to authentically welcome the voices of our interprofessional team members, chaplains, social workers, and so we have true interprofessional collaboration.

Attendee 15: And so I’m most hopeful for our younger generation so that I can retire.

Eric: Ben, when you think about the future for hospice palliative medicine, what worries you the most?

Attendee 16: Not being able to be involved as early as we all would like to be in the course of any patient’s trajectory of their illness.

Attendee 17: There’s not enough of us doing this great work.

Attendee 18: The science.

Eric: Tell me more.

Attendee 18: Teaching researchers the basic sciences of research, I think is a weak part of the training.

Eric: That’s why I love reading your articles, always so deep in science.

Attendee 5: So what I worry about is always this pressure to go on the cheap and to trim and not recognize that the recipe must be complete for the outcome to be what we need it to be.

Eric: And when do we expect that article to come out?

Attendee 5: I should hope it’ll be out within the next three to four months. Angels of Palliative Medicine.

Eric: I think we got a new GeriPal podcast coming up in the next three to four months. I don’t think we’ve had Martha on the podcast, have we yet?

Attendee 5: No.

Eric: How did we do that?

Attendee 5: Gosh, I listen to you guys every week!

Eric: Shaida, when you think about the future of hospice and palliative medicine, what are you most worried about?

Attendee 13: I am worried about workforce shortage. I’m worried we need amazing clinicians. We need good Docs. We need good nurse practitioners. I am worried we may not have enough people to serve the needs of our seriously ill patients.

Attendee 1: I’m more hopeful than worried about how things are going to go.

Eric: You’re a hopeful person.

Attendee 1: Yeah, I am.

Attendee 9: I think we still haven’t figured out how to get around the stigma, and I’m a hospitalist, so I see that all the time, and I work with really sick, older adults. And I think with the Medicare hospice benefit not meeting the needs of older adults, it’s very hard to even have a segue to have those conversations because you can’t really offer people a path forward in a way that aligns with their values.

Attendee 14: I am worried that we are not going to be able to meet the need, and that we have so many different illnesses and so much content now. How do we keep that all together as we care for more and more diverse populations?

Attendee 15: I do worry about access, particularly in rural areas and for-profit hospitals, and ensuring that there’s equity of access outside of academic medical centers. As well as that really, we need to keep caring forward with what Tim Quill and Amy Abernethy talked about in 2013, about really a big part of our specialty is potentiating the primary palliative care that’s done by non-specialists, and how do we embrace that even further to carry our message further?

Eric: Okay. Sarah, when you think about the future of hospice palliative medicine, what are you most worried about?

Attendee 9: I am actually worried that we will continue to grow too rapidly and we won’t have enough people to really properly do the work. We’ll have too many consults, and it’s sort of a double-edged sword that people appreciate us and understand what we’re doing, but we may not have all the trained palliative care chaplains, and palliative care social workers, to really meet those specialized needs. So I worry about burnout for our teams, but I’m hopeful that we can continue to grow and educate each other.

Eric: [funny blooper] Sarah, when you think about the future of our field, wait, did I ask worried or hopeful?

Attendee 9: You already asked for hopeful. [laughter]

Eric: [funny blooper] Okay, Sarah, second question. When you think about the future of our field, what are you most hopeful for?

Attendee 9: Most hopeful?

Eric: Did I do that again? [laughter]

Attendee 9: Did you not like my answer? [laughter] Take two.

END OF VIDEO:

Eric: Well, that was great. We got some great ideas of what people are hoping for or worried about.

Alex: But wait, before we end, Eric, when you think about the future of hospice and palliative care, what worries you the most?

Eric: Oh, a great question, Alex. I wish I thought about that question before. [laughter]

Alex: It’s all fair, right? This is what we did to the people at the conference conference.[laugher]

Eric: Dang it. Well, I am actually most worried about where we’re going with the field, especially with hospice, where hospice is going with a lot of variability in the care that seems to be delivered. One out of six hospices in the United States are in Los Angeles County for some strange reason.

Alex: The eyebrows go up.

Eric: Eyebrows go up, and you got to wonder what the heck is going on with our field. And I feel like if we’re not taking leadership in charge, in trying to protect the most vulnerable patients and thinking about how do we get people to the best quality of care, which includes the best hospice, we are not doing our jobs as hospice and palliative care clinicians. So that’s what I worry about most.

Alex: All right. And when you think about the future of hospice and palliative care, what are you excited about the most?

Eric: I’m always most excited about the new people coming into the field. They inspire me to do the work that I do. From fellows to other trainees, to chaplaincy trainees. I think AAHPM really inspired me too, meeting a lot of people just coming into the field. So I am most inspired and hopeful to see what they do with the field. Alex, what are you worried about?

Alex: Oh, wow. I was not expecting this question. [laughter]

Eric: Sucker.

Alex: All right. Somebody told me today that private equity is buying inpatient hospice teams. I don’t know if that’s true, but I just wanted to say that if there is this concern, this builds on what Eric was saying, this trend of equity buying hospices, buying assisted living facilities.

Eric: Buying GeriPal podcasts.

Alex: Nursing homes. Yeah.

Eric: Here’s our contact information.

Alex: This podcast was brought to you by, we have a new sponsor.

Eric: BlackRock. [laughter]

Alex: That’s right. So yes, that concerns me. That’s what concerns me the most.

Eric: What are you hoping for, Alex?

Alex: I’m hopeful that … Eric and I are getting up there.

Eric: Wait, wait, wait. You’re saying we’re retirement age?

Alex: We’re still a little ways away from retirement age, but nonetheless, I’m hopeful-

Eric: Alex is hopeful we sell out to a private equity and he can retire. [laugher]

Alex: I’m hopeful that there will be some people listening to this who are the future content creators in the geriatrics and palliative care space, and I look forward to what they have to offer.

Eric: Well, thanks everybody, and we’ll do this next AAHPM and HPNA meeting, word on the street, but not in the meeting because it is not associated with AAHPM or HPNA.

Alex: Just to be absolutely clear.

Eric: Absolutely clear if you haven’t got that message. It is not in any way sponsored by AAHPM or HPNA. And with that, thanks everybody.